COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)APPLICATION FOR APPOINTMENT TO THE CRIMINAL JUSTICE ACT PANEL FOR THE DISTRICT OF CONNECTICUT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomCJA Panel members represent indigent defendants who are charged with criminal offenses in Federal Court, at both the trial and appellate level. Panel members may also be called upon to provide representation to habeas corpus petitioners. The Court seeks dedicated attorneys with experience and proven competence in the area of federal criminal defense. The qualifications of applicants will be examined by the Standing Committee on the Criminal Justice Act, who will make recommendations to the Judges concerning membership. The District Judges ultimately determine who shall be appointed to, and remain on, the Panel. ALL QUESTIONS MUST BE ANSWERED FOR YOUR APPLICATION TO BE ACCEPTED FOR CONSIDERATION.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Submit one original and five copies of completed applications to:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Victoria C. Minor Chief Deputy Clerk U.S. District Court 141 Church Street New Haven, CT 06510(Attorney must sign above and type name below)Attorney(s) forAny inquiries can be directed to the Clerk's Office at (203) 773-2140.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Application for Appointment to the CJA Panel Revised 4/24/03Page 1Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT APPLICATION FOR APPOINTMENT TO THE CJA PANELJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)A.General Information 1.Name:(Last). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(First)(Middle)2.Office Address: (Firm Name)THE PEOPLE OF THE STATE OF NEW YORK TO(Street)(City)(State)(Zip)3.Telephone Numbers: (Office)GREETINGS:(Home) (FAX)WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable(Pager) , (Mobile)located at County of(Internet E-mail)o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room5.Federal Bar Number: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.6.Date Admitted to Connecticut Bar (state): , one of the Justices of the7.Date Admitted to District of Connecticut Bar (federal): Court in Witness, Honorableday of, 20 County,8.Date Admitted to Second Circuit Bar: (Attorney must sign above and type name below)9.Attorney(s) forList other Federal Districts to which you have been admitted: Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Application for Appointment to the CJA Panel Revised 4/24/03Page 2Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.10.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)List other Circuits to which you have been admitted: 11.Admitted to the Supreme Court Bar? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .No THE PEOPLE OF THE STATE OF NEW YORK TO12.Law School from which you received your JD: Year: GREETINGS:13.WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableSocial Security Number (required for ALL CJA payments): ,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room14.I request that all CJA payments be reported to IRS (initial one): Under my name and social security number Under the name and taxpayer I.D. of my law firm: Name of firm Address Taxpayer Identification Number Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)15.Attorney(s) forPlease list any foreign languages in which you are fluent: Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Application for Appointment to the CJA Panel Revised 4/24/03Page 3Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.16.At which seat(s) of court are you willing to accept appointments: HartfordJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s) New Haven BridgeportB.Professional Experience 1.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Please complete the following for each professional employment held during the past 15 years (duplicate this section if necessary): Employer, firm or agency Address Telephone (THE PEOPLE OF THE STATE OF NEW YORK TO)GREETINGS:Supervisor or managing partner Title or position(s) you held (e.g., a
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